Why has my cheek melasma become darker over time?

Question

Hello doctor,

I am experiencing melasma mainly on my cheeks. It has been one year, and the marks have become darker and more noticeable. Earlier, it was thought to be due to a low hemoglobin 13.2 (g/dL) level, but now my hemoglobin level is normal.

However, the pigmentation has recently become more visible. I was using GK Whitening Cream before, but I am not using it now. What steps should I take to manage this?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

The condition described, including brown patches on both cheeks present for about one year, is consistent with melasma, which is a common form of facial hyperpigmentation.

First, it is important to clarify that a hemoglobin (Hb) level of 13.2 grams per deciliter (g/dL) is within the normal range. Melasma is not directly caused by low hemoglobin levels. However, iron deficiency and anemia are different conditions.

In some situations, a person may have normal hemoglobin but still have low iron stores. For this reason, it may be helpful to check:

Serum ferritin.
Serum iron.
Total iron-binding capacity (TIBC).

If these tests show low iron levels, a doctor may recommend an iron supplement such as Ferrous fumarate taken once daily after meals for a short duration under medical guidance.

Melasma itself is usually multifactorial, meaning it can occur due to several factors, including sun exposure, hormonal changes, genetic predisposition, or the previous use of steroid-containing skin-lightening creams.

Since skin whitening cream was used previously, there is a possibility of steroid-induced rebound pigmentation, which can make pigmentation appear darker after discontinuing the cream. This can happen when products containing topical Corticosteroids are used for prolonged periods.

For treatment, strict sun protection and gentle skin care are the most important steps.

A mild cleanser can be used, followed by a moisturizer such as ceramide-based moisturizers applied twice daily to maintain the skin barrier.
In the morning, apply a broad-spectrum sunscreen with sun protection factor (SPF) 30 or higher, which protects against ultraviolet A (UVA) and ultraviolet B (UVB) rays. Sunscreen should be reapplied every three to four hours if there is continued sun exposure.
At night, topical depigmenting agents can be helpful. Azelaic acid may be applied in a thin layer over the affected areas. In some cases, Tranexamic acid topical formulations or Kojic acid may also be recommended by a dermatologist. Consistent use for eight to 12 weeks is usually required before visible improvement is noticed.
Avoid harsh scrubs, frequent facials, or steroid-containing creams, as these may worsen pigmentation.

Routine blood tests are not always necessary, but if symptoms such as fatigue, hair loss, or heavy menstrual bleeding are present, tests such as:

Serum ferritin.
Thyroid function tests (TFT).
Vitamin D level.

With proper skin care, sun protection, and consistent treatment, melasma can gradually improve over time, although it may require several months of treatment.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.